Provider Demographics
NPI:1861146268
Name:POPPELLSTONE LLC
Entity type:Organization
Organization Name:POPPELLSTONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:POPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-812-8285
Mailing Address - Street 1:4114 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-9337
Mailing Address - Country:US
Mailing Address - Phone:325-274-8811
Mailing Address - Fax:
Practice Address - Street 1:4114 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-9337
Practice Address - Country:US
Practice Address - Phone:325-274-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care